Premium Surcharges
HIPAA
A group health plan may not charge higher premiums based on a health factor, except under a compliant wellness program. Note: Vaccine status is a “health factor.”
HIPAA Considerations: Compliant Wellness Program
Surcharge Limits
The total of all surcharges under the wellness program may not exceed 30% of the cost of coverage – 50% if the program includes a tobacco incentive.
Waivers
The program must permit waivers or allow participants to complete a reasonable alternative standard.
Avoidance Opportunity
Participants must be given the opportunity at least once a year to avoid the surcharge.
Disclosure
The plan must disclose the terms of the wellness program in writing.
HIPAA Privacy- Resources
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Workplace guidance on HIPAA and vaccine status disclosures
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HHS Office of Civil Rights FAQs on HIPAA, COVID-19 Vaccination, and the Workplace
